Orthopedist Questions Knee Problems

I have chronic knee pain

I have had right knee pain since I was 9 years old and I am now in my 50s. I have had 3 surgeries to "clean up and straighten up" my knee. At what point should I give up and have a knee replacement?

33 Answers

You should never give up. You should find a doctor who will tell you that he can fix what is going on with you. I do not know where you live, but if you can find a doctor who does surgery on Pro Ball players, they can most likely fix what is going on or tell you what is best for you.

I wish you well.
With such a long past medical history of knee problems, you must have by now a good, reliable orthopedic surgeon who specializes only in knees. He/she will advise you on this matter. It looks as though you are at the age when you deserve to feel pain-free and get your life back. A knee replacement could be (as it sounds) your next step to follow.
Knee replacement is indicated only when your activities of daily living are significantly compromised
Dictated by your pain level, failure of conservative treatment and quality of life issues
That depends on how old you are. Knee replacement surgery is not a panacea for knee pain. The prosthesis will wear out in time. The speed with which it wears out depends on things such as your weight and what kind of activity you plan on continuing. This is a great question to bring up to an orthopedic surgeon who you trust.
When the pain interferes with your activities of daily living, sleep, and recreational activities, that's the time to consider joint replacement surgery. Have you tried the viscosupplement injections - Synvisc or Supartz? They can diminish pain of mild to moderate OA. If your knee pain is bone on bone, then those injections are not likely to help you.

Good luck!
In the 70-80 s
When the arthritis is so bad that you cannot handle it anymore or when all other treatments have failed.
Given your age, multiple surgeries and history, you probably need the total knee now. I can only generalize my response without seeing recent X-Rays.

It sounds as though you have exhausted all of the available "other" options.
In my opinion, the determining factors for proceeding with knee replacement are yours.

if the pain, loss of motion, weakness, and lack of mobility are compromising your quality of life, interfering with your work responsibilities, or are just too much to bear; you should seriously consider knee replacement.

I have had a right knee replacement and don't regret doing so.

Of course the replacement is not without risk and potential for complications, which you should discuss with your surgeon.

I put off having it done for almost 5 years due to the responsibilities of my position in the Army. In fact I did a nighttime combat equipment parachute jump the night before my fifth and final right knee scope. Yet, I still put it off for another 3 years.

I wouldn't advise waiting as long as I did. I returned to full time work as an Orthopedic Surgeon in about four weeks. Two years after the knee replacement, I was able to complete The National Ski Patrol training and have been doing that in addition to Hand Surgery since. The TKA takes about 2-3 years to get as good as it will optimally become.
For further information I would recommend that you purchase an excellent book called "The Knee Owner's Manual". It is written by a very good friend of mine, Jeff Falkel PT PhD. He wrote the book after having both of his knees replaced. It is very comprehensive, illustrated and a very enjoyable read.
You can purchase it on Amazon for about $20.
I hope that this has been helpful.
This is not a question they can be answered without a comprehensive physical, series of x-rays for the knee, and review of previous surgical interventions. I would recommend having an evaluation by an orthopedic surgeon to discuss your particular situation.
Have you tried PT? Have you discussed this with your surgeon? How active are you? How does this knee pain limit your daily life?

All great questions to reflect on when making a decision about whether to have surgery or whether to try and manage conservatively.
It sounds like you have developed arthritis at this point. There are conservative options such as therapy and various types of injections to try first. The injections could be corticosteroids, viscosupplementation, platelet rich plasma, or stem cells. Some of those are covered by insurance and some are not. If you have tried all of those options and you are still in pain, then it may be time to consider knee replacement. Yes, you are still young for a knee replacement and you might need to have a revision in 20 or 30 years. However, it's about quality of life. If you are unable to enjoy life and are choosing to avoid certain activities or events because of your knee pain, then it is appropriate and recommended to have the replacement. Of course the diagnosis and decision would need to be preceded by an exam with an orthopedic surgeon. Also, the rest of your medical history would need to be evaluated first to make sure your healthy enough for surgery.
You should only consider a knee replacement once you have failed all conservative and less invasive measures. Although it is reasonable to have a knee replacement in your 50's, it would be preferable if you are older to reduce the risk of needing another surgery. Other measures include injections, bracing, and physical therapy. However, if you symptoms cause difficulty with sleep or basic activities or bother you more than 50% of your day with conservative treatment, you may be a candidate for a knee replacement. please go to www.MichaelLimMD.com to schedule an appointment.
It really depends on several factors. Maybe the realignment you had was not enough and you may need further surgery to make the knees perfectly straight
The decision to proceed with knee replacement is easy for some patients, but may not be so easy for others. As I so often tell my own patients in the office, I don't tell you when to have knee replacement, you tell me.

How does one know that it is time for knee replacement surgery? Here are some of the points of advice I give to my patients:

1. Does the pain occur every day?
2. Does the pain wake you up at night?
3. Does the pain keep you from the activities you need or want to do?
4. Do you have to limit your work activities due to your knee pain?
5. Do you find yourself declining to have experiences or do activities with friends and family because of your knee pain?
6. Do you find yourself saying "I can't" when asked to do active things or when you think about wanting to do active things?
7. Have you tried steroid (cortisone) injections and hyaluronic acid (rooster comb or
Gel) injections without relief or decreasing effectiveness?
8. Do you require pain medicine (NSAIDs or opioids) stronger than Tylenol on a daily basis?
9. Have you tried bracing (compression, correction of instability or bowing/knock knees) without relief?
10. Have you tried a supervised exercise or physical therapy program without relief?
11. If you are overweight, have you undergone weight loss without pain relief?
12. Do X-rays of you when you stand up show bone on bone (end stage) arthritis?

If you answer yes to all or most of these questions, then you are a candidate for knee replacement surgery. I recommend that you seek out a consultation with an orthopedic surgeon who is fellowship trained in or specializes in total joint replacement to discuss your options.

Thank you for your question.

Kenneth Brooks, M.D.
The primary indication for knee replacement surgery is unrelenting pain from arthritis of the knee. If you have arthritis of your knee and feel like your quality of life is not acceptable, you can consider knee replacement surgery if it is unresponsive to non-surgical options. You would need to see an orthopedic surgeon for an evaluation and X-rays.
KNee replacement is a lifestyle changing surgery . The primary indication is if your life is dominated by pain in the knee and affecting your work , social life and Activities of daily living
Yes is the short answer. A knee replacement should straighten your knee and give you long-lasting pain relief.
If you have chronic knee pain and are a candidate for a knee replacement, speak with your orthopedic surgeon. There have been many medical advancements in joint replacement technology that improve the longevity of the joint. I'm treating a 42 y/o active patient right now with a total knee replacement. No need to suffer in pain!
Before you consider a total knee you have to know the reason for the knee pain. There is no guarantee that the total knee will get rid of all your pain. Was the pain from your knee cap, discoid meniscus, arthritis, synovitis? There is no simple answer but PLEASE don't think that a total knee will answer all your problems
After exhausting all nonoperative management including oral medication, activity modification, injections (either steroid or hyaluronic acid), I recommend patients consider knee replacement. Other options which are not covered by traditional insurance are stem cell therapy or platelet rich plasma (PRP) injections. A standing X-ray of your knee would best assist in which treatment is best.
Exercise has been shown to be quite helpful. Work on range of motion and flexibility first. Then work on non-impact strengthening, conditioning and endurance exercises.
It depends. It would be a good idea to have you schedule an appointment for an assessment, exam and updated X-rays to help determine your best treatment options.
Charles Beck MD
You are still young for knee replacement you need further conservative care This would include medications injections braces physical therapy chronic pain management.
The days of saying that a patient has to be a certain "age" to get a total knee replacement are rapidly evaporating. In my office, we evaluate you as an individual. We take into account the x-rays and the signs of arthritis, but just as importantly I as want to know how you knee is impacting you. Are you a laborer who cannot work because of the knee? can you not play your sport of hobby or garden because of your knee? Do you resist simple pleasures such as going to the mall or walking the boardwalk in the summer because of your knee. Those answers, coupled with the presentation of appropriate radiographic findings will guide us to whether it is time to consider the replacement. I believe we all deserve a quality of life and enjoyment and that should not be pushed off for an arbitrary "age"
You should consult an Orthopedic Surgeon who specializes in total joint replacement surgery and have him perform a complete evaluation. I would suggest a surgeon who is part of a medical school faculty, and would rely on his expertise. Good luck!!

Joseph E. Ronaghan, MD, FACS, FICS
Associate Professor, Dept. of Surgery
If you have documented arthritis on xray, continued pain despite having
clean up surgeries, medications and injections AND you are having
limitations to your activities then you may be a candidate for knee
replacement surgery.
Knee Replacement is a lifestyle changing surgery .

Pain is the primary indication of this surgery .

Unfortunately, there was a bit of misinformation listed on the website. I am a sports medicine PODIATRIST and not a family practitioner.

My primary focus is on conditions of the foot, but I do help my patients to address certain types of knee pain as it relates to the alignment of the lower extremity. It sounds like your knee situation is a bit more complex and chronic than that. It also sounds like you've already seen an orthopedist (or two or three!).

I would suggest getting at least another opinion or two from the top knee replacement specialists in your area. Ask them if there is arthritis in your knee that is severe enough to warrant a knee replacement. Also, ask them the chances of achieving at least temporary relief from hyaluronidase injections or even PRP or amniotic membrane injections.

I hope that's helpful!

Dr. Richard Graves
When your knee pain or the function of your knee prevents you from leading the life you want to live.
If the cartilage is now severely degenerated, the knee will need replacement. Pain is the real reason to get a knee replacement.
Answer to the Knee problem

From the brief description, you may be a candidate for a knee replacement. However, I'm an academic orthopaedic surgeon and could never advise without seeing you, taking a detailed history, a complete knee examination and reviewing current X-rays including weight bearing views', then you get a well thought out and correct opinion.

Dr Clive Segil, M.D
Thank you for your question. A knee replacement is done when you have severe arthritis in your knee. This will cause pain, instability, and loss of knee motion. At your age, you will find your ability to participate in activities compromised. If you have exhausted all the non-surgical and non-total knee surgery that can be offered to you, consider a knee replacement. If you are in good health and not overweight, more likely than not, you will have a good result, that will last for 2 decades or more. Ultimately, consider a knee replacement when your knee problem is affecting your lifestyle, and you are not doing the things you want to do at your age.

X-rays and an examination will confirm the diagnosis of arthritis. Your surgeon can discuss the operative procedure, risks and expected outcome. Patients your age can be very active, if they do the appropriate amount of post operative physical therapy and muscle strengthening. This might include golf, bowling, biking, hiking, even skiing.

Dr Irving